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Aetna Medicare Premier (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$70.00
Monthly Premium
Aetna Medicare Premier (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H5521-015
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Aetna Medicare Premier (PPO) - H5521-015 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$70.00
Monthly Premium
District Of Columbia Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $7500 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network $0 Out-of-Network $10 |
| Specialty Doctor Visit | Out-of-Network|$60 |
| Inpatient Hospital Care | Out-of-Network|50% per stay |
| Urgent Care | Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $115 Maximum Plan Benefit of $250,000 |
| Emergency Room Visit | $115 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance Transportation | In-Network $275 Out-of-Network $275 |
Health Care Services and Medical Supplies
Aetna Medicare Premier (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 20% |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network 0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies 20% for other covered diabetic supplies Out-of-Network 0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies 20% for other covered diabetic supplies |
| Durable Medical Equipment (DME) | In-Network 0% for continuous glucose monitors 20% for all other Medicare-covered DME items Out-of-Network 20% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network $0 Out-of-Network 20% Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $0 for services provided by your primary care provider in their office $100 for services performed by a provider other than your primary care provider Out-of-Network 20% Imaging: In-Network Xray: $0 for services provided by your primary care provider in their office; $50 for services performed by a provider other than your primary care provider CT Scans: $0 for services provided by your primary care provider in their office; $375 for services performed by a provider other than your primary care provider Diagnostic Radiology other than CT Scans: $0 for services provided by your primary care provider in their office; $375 for services performed by a provider other than your primary care provider Diagnostic Radiology Mammogram: $0 Out-of-Network 20% |
| Home Health Care | In-Network $0 Out-of-Network 20% |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $260 per day for days 1 to 8 $0 per day for days 9 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network $40 for Mental Health - Group Sessions $40 for Mental Health - Individual Sessions $40 for Psychiatric Services - Group Sessions $40 for Psychiatric Services - Individual Sessions Out-of-Network 20% for Mental Health Services- Group Sessions 20% for Mental Health Services - Individual Sessions 20% for Psychiatric Services - Group Sessions 20% for Psychiatric Services - Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $240 all other ambulatory surgical center services Out-of-Network 50% |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 20% Coinsurance for Medicare Covered Group Sessions 20% |
| Over-the-counter (OTC) Items | CVS Over-the-Counter (OTC) Wallet with a $30 quarterly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions. |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $50 Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $60 |
| Skilled Nursing Facility Care | Out-of-Network|50% per stay |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network Preventive dental services: $0 for oral exams $0 for cleanings $0 for x-rays Comprehensive dental services: 20%-50% for restorative services 20% for endodontic services 20%-50% for periodontic services 50% for removeable prosthodontics 50% for fixed prosthodontics 20% - 50% for oral and maxillofacial surgery 20% - 50% for adjunctive services Out-of-Network Preventive dental services: 50% for oral exams 50% for cleanings 50% for x-rays Comprehensive dental services: 50% - 70% for restorative services 50% for endodontic services 50% - 70% for periodontic services 70% for removeable prosthodontics 70% for fixed prosthodontics 50% - 70% for oral and maxillofacial surgery 50% - 70% for adjunctive services $1,000 benefit amount (allowance) every year in and out-of-network for covered comprehensive dental services. Frequencies and medical necessity requirements vary by covered dental service. Covered preventive dental services do not count towards your annual benefit amount. See EOC for additional details on exclusions and limitations. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network Eye Exams: $0 for Diabetic eye exams $50 for all other Medicare-covered eye exams $0 for non-Medicare covered eye exams Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network with an EyeMed provider Eyewear: $0 for Medicare-covered prescription eyewear $0 for Contacts $0 for Eyeglasses $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Upgrades Out-of-Network Eye Exams: $60 for Medicare-covered eye exams $0 for non-Medicare covered eye exams Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50) Eyewear: 50% for Medicare-covered prescription eyewear $0 for Contacts $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Eyeglass Lenses and Frames $0 for Upgrades $200 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network Hearing Exams: $50 for Medicare-covered hearing exams $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year in or out-of-network) $0 for fitting/evaluation for hearing aids (Maximum one hearing aid fitting/evaluation every year) Hearing Aids: $0 for hearing aids $500 benefit amount (allowance) per ear, every year for hearing aids (Maximum two hearing aids every year) Out-of-Network: Hearing Exams: $60 for Medicare-covered hearing exams $60 for non-Medicare covered hearing exam every year in or out-of-network Hearing Aids: You must purchase hearing aids through NationsHearing |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network $0 for all preventive services covered under Original Medicare Out-of-Network 0% for the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines 50% for all other preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Premier (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|